This essay focuses on the ethical considerations and implications of providing a universal multi-cancer screening test as the best approach to reduce societal cancer burden in a society with limited funds, resources, and infrastructure. With 1.9 million cancer diagnoses each year in the United States, with 86% of all cancers diagnosed in individuals over the age of 50, and with screening tools approved for only four cancer types (breast, cervical, colorectal, and lung cancer), it seems that a multi-cancer screening test to detect most cancer early that is easy to administer, and is accurate and cost-effective, would be worth considering. Whole-body magnetic resonance imaging and a multi-marker blood test are the two main technologies that we will discuss as a universal screening test. However, to understand and appreciate the societal and clinical breakthrough of such a screening test, we must first consider the accessibility and efficacy of current screening methods. We conclude with a closer examination of the ethical implications of implementing the Galleri test as a multi-cancer detection screening tool as adamantly advocated by the company that developed this blood-based test.

Objectives: The aim of this study was to determine the role of community preference information from discrete choice studies of colorectal cancer (CRC) screening in health technology assessment (HTA) reports and subsequent policy decisions.

Methods: We undertook a systematic review of discrete choice studies of CRC screening. Included studies were reviewed to assess the policy context of the research. For those studies that cited a recent or pending review of CRC screening, further searches were undertaken to determine the extent to which community preference information was incorporated into the HTA decision-making process.

Results: Eight discrete choice studies that evaluated preferences for CRC screening were identified. Four of these studies referred to a national or local review of CRC screening in three countries: Australia, Canada, and the Netherlands. Our review of subsequently released health policy documents showed that while consideration was given to community views on CRC, policy was not informed by discrete choice evidence.

Conclusions: Preferences and values of patients are increasingly being considered “evidence” to be incorporated into HTA reports. Discrete choice methodology is a rigorous quantitative method for eliciting preferences and while as a methodology it is growing in profile, it would appear that the results of such research are not being systematically translated or integrated into HTA reports. A formalized approach is needed to incorporate preference literature into the HTA decision-making process.

Early detection of cervical and breast cancers is an important component of women's health strategy. Screening programmes, health professional interventions and preventive behaviours such as breast self-examination provide the means to this end. Our twin study sought to identify the relative influence of environmental and genetic factors on liability to early cancer detection behaviours, including use of cervical smear tests, mammograms, and breast examination. Additive genetic and random environmental effects models gave the best, most parsimonious fit to the data for each early cancer detection behaviour. The heritability of liability to Pap smear use was 66%, mammogram use 50%, breast examination by a doctor or nurse 38% and breast self-examination 37%. Genetic influences were behaviour-specific; there was no evidence for a common genetic influence on the four behaviours. Potential covariates investigated included age, amount of contact between co-twins, educational level and personality traits such as harm avoidance, novelty seeking, reward dependence, neuroticism, anxiety, depression, self-esteem, perceived control, interpersonal dependency and ways of coping. None were significant. The study was carried out before the implementation of national screening programmes with media campaigns to increase participation rates. Hence follow-up investigation, including data on regularity of behaviours, would be informative

Concerns over low uptake of cervical screening among minority ethnic women have spurred much research and practical activity to address the problem. Due to theoretical and methodological difficulties, research in this area has tended to focus on the communication deficit of women, without addressing the social context. This has not only hindered a wider theoretical understanding of the problem but, also, has perpetuated ineffective health promotion practice in this area. Using a participatory action research (PAR) approach, the project ‘Woman-to-woman: promoting cervical screening to minority ethnic women in primary care’, tackled the problem by involving both health professionals and women from the communities. Working in partnership, both professional and lay participants identified the problems from their own perspectives and generated solutions to resolve them. An intervention strategy was formulated in which bilingual women from the communities were recruited as community health educators to provide an informed link between their respective communities and the primary care sector. The outcomes of the intervention were evaluated by all participants. This paper aims to introduce PAR as an alternative approach by presenting an overview of the study. It begins by highlighting some of the common theoretical and methodological problems encountered by researchers; and then introduces the research framework of PAR and describes the research processes. A case observation is presented to illustrate the depth of understanding of the screening processes that can be obtained using this approach. The project has demonstrated that applying PAR cannot only lead to meaningful discoveries and insights into the problem of minority ethnic women and cervical screening, but also change in health promotion practice, which would have been difficult to achieve using a conventional research model. However, this study has also revealed major limitations of PAR, which need to be addressed if the approach is to be further developed.